Morley Ana M S, Tuft Stephen J
Moorfields Eye Hospital, London, United Kingdom.
Cornea. 2006 Oct;25(9):1128-9. doi: 10.1097/01.ico.0000226362.11431.81.
Rothia dentocariosa is a common commensal in the oropharyngeal cavity but a rare human pathogen. Ocular culture has been documented only twice previously, both from vitreous samples taken in the context of endophthalmitis. These cases, and other reports of human Rothia infection, have proposed hematogenous spread from the oropharynx as the mode of transmission.
A case report of an 11-year-old boy with a progressive right corneal abscess that required penetrating keratoplasty because of corneal perforation is detailed. The keratitis recurred in the graft, leading to an almost total epithelial defect, hypopyon, and descemetocele within 3 months.
R. dentocariosa was eventually isolated from the cornea, and the patient made a rapid recovery once topical medication was altered accordingly. Microbial identification was confirmed at a reference laboratory by using partial sequencing of 16s rDNA. The father later described his son's habit of wetting the fingertip with saliva before eyelid rubbing as a means of reducing ocular discomfort.
This is the first reported case of corneal isolation of R. dentocariosa. It also suggests a direct mode of transmission of the organism to the eye by contaminated saliva.
龋齿罗氏菌是口咽腔常见的共生菌,但却是罕见的人类病原体。此前仅记录过两例眼部培养阳性的病例,均来自眼内炎患者的玻璃体样本。这些病例以及其他关于人类罗氏菌感染的报告均提出,感染途径为从口咽腔经血行播散。
详细报告了一名11岁男孩的病例,其右眼角膜脓肿进行性发展,因角膜穿孔而需要进行穿透性角膜移植术。角膜移植术后角膜炎复发,在3个月内导致几乎完全的上皮缺损、前房积脓和角膜后弹力层膨出。
最终从角膜中分离出龋齿罗氏菌,调整局部用药后患者迅速康复。在参考实验室通过对16s rDNA进行部分测序确认了微生物鉴定结果。患儿父亲后来描述,儿子有在揉眼睑前用唾液湿润指尖以减轻眼部不适的习惯。
这是首次报告从角膜中分离出龋齿罗氏菌的病例。这也提示该病菌可通过受污染的唾液直接传播至眼部。